Biopsy refers to the removal of living tissue from the site of lesion for the purpose of microscopic examination of that part and to reach a confirm diagnosis. Biopsy procedure helps in the treatment plan. It not only helps in the diagnosis but also serves as a treatment option for smaller lesions of the oral cavity by excising. If a patient is told by his dentist that oral biopsy is to be done for any oral lesion present in his mouth, it doesn’t mean that there is some malignant or cancerous condition present. Biopsy is just a diagnostic test which will further help the dentist in treatment planning.

Oral Biopsy Need

The need for Oral Biopsy arises in following conditions:

Any lesion in mouth that persists for more than 2 weeks without having any apparent cause.

An inflammatory lesion in the oral cavity which is not responding to the local treatment even after 2 weeks.

Oral lesions which presents with persistent changes in the surface tissues.

Oral Lesions interfering with local functions.

Oral Lesions which persist for more than 2weeks, have rapid growth, have bleeding tendency and is firm to touch and fixed to the surrounding tissue.

Various Types of Biopsy are:

Incisional Biopsy for Oral Lesions:

It is also known as diagnostic biopsy and is done in case of large oral lesions, which the operator suspects may be treated by some means other than surgery once the diagnosis is made or lesions in which the diagnosis will determine whether the treatment should be conservative or radical.

In this, a small portion of the lesion is removed and is examined microscopically.

The incision on the left side is correct and shows that incision should be narrow and deep than being wide and shallow.

It is done in those cases in which the oral lesion is too large to excise completely or in cases when the lesion is fixed to the nearby vital structures like nerves and blood vessels.

Some normal tissue is also included in the biopsy specimen.

Deep tissues are removed with V shaped incision in this.

Excisional Biopsy for Oral Lesions:

Excisional Biopsy is done in those cases in which the lesion is small and is less than 1cm and it is completely removed for the purpose of microscopic examination.

In this, the incision is made in an elliptic manner staying at least 3mm away from the lesion. This should be the sufficient depth for the complete removal of the lesion.

Incision in elliptic manner in Excisional Biopsy. Normal tissue is also removed along with the lesion.

Convergent incisions are done and the tissue is removed.

Section of the tissue can be taken from the scalpel, cautery or high frequency cutting knife or lasers. Scalpel is the instrument of choice as it cleanly removes the tissue and doesn’t dehydrate as cautery or high frequency cutting knife. Cautery and high frequency cutting knife is of great value in dealing with vascular lesions where it controls the bleeding at the biopsy site.

Frozen Section Biopsy for Oral Lesions:

It is done to get an immediate histological diagnostic report of the oral lesion.

A portion of the lesion is removed from the site and is kept frozen. Then it is sectioned, stained and is examined microscopically.

In frozen section Biopsy, the slides can’t be preserved for the future references.

Punch Biopsy for Oral Lesions:

Biopsy Punches with Plungers

In case of punch biopsy, punch is used to remove the circular piece of tissue that is to be examined.

It is convenient to remove a piece of tissue, particularly from the posterior oropharyngial region.

Fine needle aspiration cytology (FNAC) for Oral Lesions

In this, the tissue material is aspirated from the deep seated, glandular or the cystic lesions where the accessibility is not possible from the outer surface.

Brush Biopsy is used to detect oral cancer. Spots and lesions on lips, throat, tongue and gums are evaluated. Brush biopsy test is very convenient for dentist and the patient. No anesthesia is required for the procedure. With a soft nylon brush, transepithelial biopsy specimen is obtained and specimen is then analyzed by computer. Results are very accurate. Staff pathologists also review the slides.

No special precaution is taken before oral biopsy procedure and after appointment; the biopsied area might be sore and cause discomfort for which pain meds can be given to the patient. .